Modifications to CMS' Meaningful Use Rule Finalized for 2014

AAFP Appreciates Added Flexibility, Laments Poor Timing

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have finalized a rule that provides guidance to family physicians and other health care professionals who are navigating the Medicare and Medicaid EHR (electronic health record) Incentive programs.

A couple of caveats: The rule applies largely to physicians who were scheduled to attest to meaningful use stage two for the first time in 2014 and had trouble implementing a 2014 edition certified EHR technology (CEHRT).

In addition, physicians who were to attest to meaningful use stage one could possibly attest to the 2013 edition of stage one; those who were to attest to stage two can attest to the 2013 or 2014 version of stage one. (The details are confusing, so take a look at the chart titled "CEHRT systems available for use in 2014" in CMS' Aug. 29 press release(cms.gov) for clarification.)

"We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs (going) forward," said CMS Administrator Marilyn Tavenner, M.A., in the release, which lays out an updated overall meaningful use timeline in addition to the graphic that outlines how and when CEHRT is to be used for meaningful use reporting.

Story Highlights

CMS and the Office of the National Coordinator for Health Information Technology have released a final rule that provides guidance to physicians who were scheduled to attest to meaningful use stage two for the first time in 2014.

The rule lets physicians use 2011 certified electronic health record technology (CEHRT) -- or a combination of 2011 and 2014 CEHRT -- to complete a 90-day reporting period in 2014.

Eligible health care professionals, hospitals and critical-access hospitals must use 2014 certified product for meaningful use reporting in 2015.

Tavenner noted that CMS identified ways in the final rule to help physicians, hospitals and critical-access hospitals implement and use certified EHR products. Specifically, the rule states that

physicians and other eligible providers can use 2011 certified technology -- or a combination of 2011 and 2014 CEHRT -- to complete a 90-day reporting period in 2014, and

all eligible health care professionals, hospitals and critical-access hospitals must use 2014 certified product for meaningful use reporting in 2015.

The final rule also extends meaningful use stage two through 2016 for some providers and sets the stage three timeline to begin in 2017 for physicians and other eligible providers who became EHR meaningful users in 2011 or 2012.

In an interview with AAFP News, Steven Waldren, M.D., director of the AAFP's Center for eHealth Innovation, said the AAFP appreciated the flexibility the rule would give family physicians.

"We need the flexibility because practices are struggling to achieve meaningful use stage two, and there are obstacles outside of their control; now people can revert back to stage one, if necessary, and that is good," said Waldren.

However, Waldren took issue with the timing of CMS' decision.

"Physicians need time to read through the rule or to wait for their membership organizations to decipher some very complex regulations to help figure out what can and cannot be done.

"This rule should have been finalized months ago; October is the start of the last quarter," said Waldren, and the last chance for physicians to attempt quarterly meaningful use reporting.

For physicians who were to do meaningful use stage two reporting in 2014, that's important, because on Jan. 1, 2015, physicians will have to begin reporting for a full year at stage two.

"Come Jan. 1, there is no grace period to start doing reporting. So from now until the end of the year is the only time family physicians have left to fully implement a 2014 product and ensure that it can handle all the tasks it's being asked to do," said Waldren.

"Physicians who take advantage of the flexibility to do stage one reporting instead of their required stage two have to be up and running with their fully functional 2014 edition certified EHR on the first day of business in 2015," he added.

Waldren lamented that CMS and ONC did not add more flexibility -- as requested by the AAFP and many others -- into the reporting period in 2015. "Letting physicians report for one or two quarters rather than the entire year would have given physicians more time to fully implement their EHRs," he said.

Waldren urged family physicians to continue their implementation efforts: "Put the accelerator to the floor because come Jan. 1, you'll have to do stage two," he said.

For the remainder of this year only, physicians can still ensure that they're hitting their measures for stage one and then go back and find the one quarter where they met stage one measures, and then base their attestation on that one quarter.

The AAFP wasn't the only stakeholder organization anxiously awaiting the final rule.

The College of Healthcare Information Management Executives (CHIME) released a statement(www.cio-chime.org) that also recognized the flexibility provided by the final rule but expressed dismay that CMS and the ONC chose to require 365 days of EHR reporting in 2015.

"CHIME is deeply disappointed in the decision … This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014," said the statement.

The statement added that nearly all stakeholder groups had urged CMS to "give providers the option of reporting any three-month quarter EHR reporting period in 2015."

"This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar without pushing them off the cliff, and it would have ensured the long-term vitality of the program itself," said CHIME.

Waldren added that a "good chunk of docs" -- and not just family physicians -- looked at the requirements for meaningful use stage two and threw up their hands.

"They looked at the lack of availability of 2014 certified products and said, 'I can't make it; there's no way, so I'm just going to go back to seeing patients, focus on quality and not worry about these meaningful use measures.'"

Waldren is combing through the final rule to ensure the AAFP will be able provide the best support to members as they move forward. Stay tuned for more information on that front.